CERT First Aid - April 2009

1. CERT First Aid - April 2009 Welcome Back!Class #7

2. Class #7 Outline Manual Immobilization of Head Log Rolling Use of Cervical Collars and Backboards

3. Disaster First Aid Care Outline Make Victims Safe for the Moment Assess Safety � can I approach, are victims in danger Perform quick assessment of Victims Prioritize and rescue as needed Treat immediate threats (Airway, Bleeding, Shock) Make Victims Comfortable and Stable Decide on treatment priority Perform initial and detailed assessment on each victim Treat injuries to protect from further injury or deterioration Document findings and treatment given Transport Victims to Central Facility Decide on transport priority Decide on transport mechanism Decide on transport path Prepare transport team and supplies Repeat for each Scene for which you are Responsible

4. Spinal Injuries require Special Consideration If there is a fracture of the spine, any movement may result in permanent paralysis � If you suspect a spinal�injury, take extra care to make sure that the spine does not bend, twist, or move in any uncontrolled way. Pay attention to how you move the victim Pay attention to how the victim moves, either voluntarily or involuntarily

5. When to Suspect Spinal Injuries Any situation that involves substantial force Impact from large heavy objects - car, furniture, etc. Fall from significant height Person thrown from vehicle Motor vehicle accident Any time there is a complaint of pain or pressure in the back or neck Any deformity or swelling in the�neck or back Any paralysis, tingling,�or numbness�in a body part Any change in consciousness Any evidence of a blow to the head Blood or fluid draining from the nose or ears Bruising around the eyes or behind the ears Unequal pupils Seizures

6. Skills for Handling Spinal Injuries ��� As soon as Spinal Injury is suspected Apply Manual Stabilization Position rescuer above or behind victim�s head Make sure rescuer is comfortable before touching head Place hands on either side of head Keep head from moving relative to shoulders Use Modified Jaw Thrust if needed to keep airway open Place fingers on either side of jaw Place thumbs on cheek bones Push up on jaw and down on cheeks

7. Skills for Handling Spinal Injuries ��� If you must move the victim Use Log Roll Technique Requires at least 3 rescuers First rescuer is at head, controls head, and is in charge of all movements Victim�s arms should be down at victim�s sides Victim�s legs should be parallel (but do not need to be perfectly straight Second rescuer kneels beside chest, and places one hand on opposite shoulder and one hand at opposite waist Third Rescuer kneels beside thigh, and places on hand on opposite hip and other hand on knee On command, both rescuers pull victim toward themselves, rolling victim onto near side First rescuer supports and rolls head to keep aligned with shoulders

8. Manual Spinal Stabilization�and Log Roll�� Video and Practice

9. Spinal Immobilization - Principles Think of the spine as a continuous chain of 26 joints, stretching from skull to pelvis If a spinal injury is suspected, must immobilize from head to hips Use Cervical Collar to immobilize neck portion Use backboard to immobilize the rest One person must be devoted to controlling the head and monitoring the victim throughout the immobilization Neck is most vulnerable to mishandling, and has the greatest consequences Be prepared for vomitting or other unexpected movement esp. if near drowning or other reason to have stomach full �����

10. C-Collar and Back Board Sequence��

11. CERT First Aid - April 2009 Welcome Back!Class #8

12. Class #8 Outline Transportation of Victims Highlights of CERT First Responder Highlights of Emergency Response

13. Disaster First Aid Care Outline Make Victims Safe for the Moment Assess Safety � can I approach, are victims in danger Perform quick assessment of Victims Prioritize and rescue as needed Treat immediate threats (Airway, Bleeding, Shock) Make Victims Comfortable and Stable Decide on treatment priority Perform initial and detailed assessment on each victim Treat injuries to protect from further injury or deterioration Document findings and treatment given Transport Victims to Central Facility Decide on transport priority Decide on transport mechanism Decide on transport path Prepare transport team and supplies Repeat for each Scene for which you are Responsible

14. Planning and minimizing transport� Plan ahead - transport path know where you are going to go and along what path know what obstacles you�will encounter and how you will overcome them consider stairs, corners, tight spaces, debris, curbs Plan ahead - resources are there enough litter bearers and do they understand their roles is the litter adequate for the task Plan ahead - contingencies What if the patient gets worse and unstable What if the path is blocked What if a litter bearer gives out What if the litter gives out

15. Protecting from harm Avoid anything that moves or presses on the injuries Consider victim's position - is flat on back best Consider where injured parts are - can they be moved away from load-bearing points on litter Are injuries sufficiently immobilized Is splint adequate Will splint be shifted when patient is loaded into litter Are injuries well padded There will be some jostling Is anything hanging outside of litter Is victim adequately secured in litter will litter need to be tilted in any direction do ties support the loads that shift with tilting

16. Protecting from harm Make sure litter is solid enough Will litter break when loaded Will flexing or bouncing cause litter to come apart � Make sure litter is suitable for load and distance Can enough litter bearers effectively grip litter Can litter be supported comfortably by litter bearers for the distance involved Is path sufficiently clear to avoid tripping

17. Commercial Litters Backboards - not recommended as litters Basket Stretchers Folding Stretchers Sleds �

18. Folding Stretcher

19. Basket Stretcher

20. Rescue Sled

21. Improvised Litters��� ��� ��� ��� Branch Litter Blanket Litter Piggyback�Carries� Rope Litter

22. Branch�Litter���������������

23. Blanket�Litter���������������

24. Piggyback Carries���������������

25. Carrying�Litters - Principles��������������� At least 4 preferrably 6�people at a time should be supporting litter Person at head is in charge Someone should monitor and talk to victim throughout transport Bearers should not all be in step to minimize swinging One person should precede litter to identify and remove any hazards Bearers should point out any hazards to those behind them Litter should be kept as horizontal as possible If shock is suspected, feet can be slightly higher If head or back injury, head can be slightly higher Victim must be secured in litter Anticipate any possible twisting or tilting

26. Break �

27. CERT First Responder Preview Respiratory Support (Airways, Bag-Valve-Mask)Reducing dislocationsTraction splintsWound cleaningWound closure � Long Term CareIllness, Chronic and Acute

28. Dislocations Dislocated joints cause serious pressure on internal structures - dislocation should be reduced as soon as possible to minimize tissue damage Reduction is beyond the scope of this course Incorrect reduction increases the risk of pinching nerves, blood vessels or other tissues between parts of joint, resulting in permanent damage Dislocation may also have an associated fracture - bone fragments may end up between bone ends in joint � The best we can do is to securely splint the joint in the position found �

29. Traction Splints Used primarily for mid-femur fracture Reduces risk of arterial damage (severe bleeding) caused by jagged bone ends Requires 2 people and proper equipment to apply effectively � Long Term Concerns Pressure issues from ankle hitch and hip strap Tension changes as muscle relaxes Can traction be maintained until advanced medical help �

30. Wound Cleaning Wounds must be cleaned to minimize the risk of infection deep infections can spread and grow bone infections are very difficult to cure septic shock may result from widespread infection This should be done by medical professionals in a sterile environment if possible Can be delayed 6-8 hours, but should not be delayed for days Inadequate cleaning increases the risk�of deep infection contaminants can be washed deeper into the wound instruments used in cleaning can introduce additional contaminants

31. Wound Closure Why close wounds reduces the risk of new contaminants entering the wound minimizes any loss of functionality reduces scarring promotes healing Why not to close wounds anaerobic bacteria that grow without oxygen cause worse infections than bacteria that thrive in air Fluids and discharge can build up inside wound, promoting pressure damage and tissue decay Wounds can be closed using: sutures (stitches), butterflies, steri-strips, glue

32. Long Term Care Bedridden people will not automatically manage their needs that require activity because of unconsciousness, weakness, apathy, unwillingness to move because of injuries, restraint such as backboards

33. Long Term Care Considerations include: Vomitus, Urine and Fecal matter are irritating to skin (e.g. diaper rash) so elimination needs to be managed and cleaned up Pressure sores develop from prolonged pressure on one area of skin Dehydration will result if fluids are not replaced The body needs nutrients to function under stress, combat disease and infection, and heal injuries Respiratory, Nervous,�and Digestive systems need regular stimulation to maintain proper functioning

34. Illness, Chronic and Acute Chronic Diabetes Heart Conditions Pregnancy Mental / Behavioral disorders Anything requiring daily medication Acute Diarrhea Stroke Seizures

35. What else is in a regular First Responder course? CPR and Rescue Breathing Oxygen Administration AED (Automated External Defibrilator)Medical and Behavioral EmergenciesEmergency ChildbirthRemoving a Helmet SafelyEMS Operations